Radial keratotomy: an unkind cut?

Surgery promising the nearsighted a life free from eyeglasses or contact lenses could lead to farsightedness, fluctuating vision or weakened corneas more susceptible to infection, according to some researchers. The controversial surgical technique called radial keratotomy received some hard knocks last week during a report at the American Academy of Ophthalmology's annual meeting in San Francisco.

First performed in the United States in 1978, radial keratotomy is designed to correct vision by changing the shape of the cornea using spokelike incisions (SN: 11/29/80, p.347). But George Waring, head of a federally funded, nine-year evaluation of the procedure, told those attending the meeting that two years after surgery one-third of the 435 patients studied still suffered from vision changes. "A major problem is a progressive instability of the vision [because] a cornea has no blood vessels and heals very slowly, sometimes taking four to five years," he told SCIENCE NEWS in a telephone interview.

Waring, a professor of ophthalmology at Emory University in Atlanta, said as the cornea heals it changes shape, altering a patient's vision. For one out of every four patients, vision in the patient's two eyes differed. Three patients in the study also developed corneal infections. Waring acknowledged there was concern that weakened corneas may lead to long-range problems if there were accidential blows to the eye or if additional surgery such as cataract operations became necessary.

On the plus side, 66 percent of the patients in the study showed what Waring considered a "generally satisfactory and acceptable outcome," no longer needing glasses or contacts.

"Those with less nearsightedness had a better outcome," Waring said. "But the problem is we can't predict the outcome for each patient." He emphasized the patient has to take a "buyer-beware attitutde," referring to advertising compaigns lauding the procedure.